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Medicare Part C Coverage


Medicare Part C coverage consists of everything Original Medicare covers and can include additional benefits. Private insurance companies offer Medicare Part C plans and establish the cost-sharing and benefits. These plans are also known as Medicare Advantage.

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In addition to inpatient and outpatient health benefits, your Medicare Part C plan may include gym memberships, transportation to and from appointments, dental coverage, and more.

What Does Medicare Part C Cover?

Medicare Part C covers many of the same benefits as Original Medicare. Often, Medicare Part C coverage includes more than what Medicare Part A and Part B cover. However, Medicare Advantage plans may require you to forfeit the convenience of Original Medicare.

If you have Medicare Part A and Medicare Part B, you are eligible for Medicare Advantage. Medicare Part C plans take the form of traditional insurance options. So, you will choose from HMO, PPO, Private Fee-For-Service, Special Needs Plans, or a Medicare Savings Account plan.

Unlike Original Medicare, you might not be able to keep your current doctors or hospitals when you enroll in Medicare Part C. So, before you choose a plan, you will need to ensure your physician will accept the specific Medicare Advantage coverage you are considering.

Outpatient Medicare Part C Coverage

Outpatient Medicare Part C coverage includes everything Original Medicare covers. Benefits include:

  • Emergency ambulance transportation
  • Primary care and specialist visits
  • Emergency room care
  • Durable medical equipment
  • X-rays, lab work, and outpatient testing
  • Occupational therapy
  • Select vaccinations
  • Mental health counseling

Your plan will provide coverage and cost-sharing requirement information in your outline of coverage. Each plan and carrier have different cost-sharing responsibilities, maximum out-of-pocket limits, and benefit amounts. If your carrier decides to cover additional services, the outline of coverage will also communicate these details.

Inpatient Medicare Part C Coverage

Like outpatient coverage, inpatient Medicare Part C coverage will mirror Original Medicare. The benefits include:

  • Inpatient hospital care
  • Inpatient rehab/mental health care
  • Hospice care
  • Home health care
  • Skilled nursing facilities

Inpatient copayments and coinsurance will vary based on your plan.

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Medicare Part C Additional Benefits

The extra coverage Medicare Advantage plans offer draws many beneficiaries to explore this coverage option. Not every plan offers additional benefits, and some may only offer one or two. Thus, it is crucial to research your plan before enrolling.

Additional Medicare Advantage coverage can include:

Often, additional benefits come with a tradeoff. Imagine you are deciding between Original Medicare and Medicare Part C coverage. In that case, it is essential to review costs related to the additional benefits and where you can use the extra coverage. Some find it challenging to find a provider who will accept their Medicare Part C benefits.

Medicare Part C Coverage Cost

Coverage from Medicare Part C can range widely in cost. Some plans offer monthly premiums as low as $0, while others can be as high as $100 or more each month. A plan’s monthly premium cost depends on the carrier and associated benefits.

Unlike Medicare Supplement plans, Medicare Part C coverage is not standardized by the government, so companies decide on cost-sharing, premium prices, and more. However, each Medicare Advantage plan follows a similar structure regarding cost.

If you enroll in a Medicare Part C plan, you will be responsible for the Medicare Part B premium, your Medicare Part C premium, and any costs up to your Medicare Advantage plan’s maximum out-of-pocket limit. A Medicare Advantage plan’s maximum out-of-pocket limit can be over $7,000 in-network and more than $10,000 out-of-network, depending on the plan.

How to Know if Medicare Advantage Coverage is Right for You

To know if Medicare Part C coverage is right for you, you must first understand your health care needs. Would you rather incur out-of-pocket costs more often in exchange for additional benefits and a lower premium? If so, and you are comfortable without the freedom and simplicity of Original Medicare, Medicare Part C may be right for you.

On the other hand, you may be more comfortable paying a slightly higher monthly premium in exchange for fewer out-of-pocket costs and no network restrictions. In this case, you are more likely to benefit from a Medicare Supplement plan.

Either way, our licensed agents can help. We can review your needs, provide a free plan comparison, and help guide you to the best plan possible. Call us at the number above or complete our online rate form now.

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Sources:

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. What is Medicare Part C, HHS. Accessed April 2022.
    https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-c/index.html
  2. How do Medicare Advantage Plans Work, Medicare. Accessed April 2022.
    https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
  3. Medicare Advantage HMO Plans, Medicare . Accessed April 2022.
    https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/health-maintenance-organization-hmo

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and MedicareFAQ.com. Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

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